The surgical management of empyema (excluding those caused by mycobacterium tuberculosis and non-tuberculous mycobacteria) is rapidly evolving towards minimally invasive, precise, and stepwise approaches. The traditional three-stage classification (exudative, fibrinopurulent, and organizing) has limitations in guiding dynamic clinical decision-making. For the first time, this consensus explicitly identifies two critical junctures in the pathological progression of empyema: "early transformation" (stage Ⅰ to Ⅱ) and "late transformation" (stage Ⅱ to Ⅲ), and thereby constructs a corresponding "identification-early warning-intervention" stepwise therapeutic framework. The consensus emphasizes that proactive debridement via video-assisted thoracoscopic surgery should be performed during the early transformation phase to halt disease progression. Conversely, during the late transformation phase, therapeutic goals should be rationally adjusted to prioritize adequate drainage, avoiding futile pleural decortication. Moreover, the consensus underscores the pivotal role of precise perioperative etiological diagnosis (e.g. metagenomic nest-generation sequencing) and standardized anti-infective therapy. Integrating practical experiences from multiple thoracic surgery centers in China and relevant evidence-based literature, this consensus formulates recommendations on the precise definitions of staging, surgical indications for each phase, key technical points, perioperative management, and training systems. It aims to promote the standardized and individualized surgical management of empyema, ultimately optimizing patient prognosis.

Objective To retrieve relevant literature on risk prediction model for methicillin-resistant Staphylococcus aureus (MRSA) infection among hospitalized patients from databases and evaluate the predictive model. Methods The literature on risk prediction models for MRSA infection among hospitalized patients was retrieved from PubMed, Embase, Scopus, Cochrane library, China National Knowledge Infrastructure (CNKI), WanFang data, and VIP database, with a time range from the inception of the database to January 1, 2024. Two researchers independently screened the literature, extracted data. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was applied to evaluate the risk of bias and applicability of the prediction model in the literature, and descriptive analysis was conducted. Results A total of 12 articles (15 prediction models) were included in this study, with significant differences in the total sample size, the number of MRSA infection events, sample size of modeling, and sample size of validation among the studies. Common predictors in the prediction models were admission to the intensive care unit, antibiotic use, history of residence in nursing facilities, age, chronic kidney disease, and previous hospitalization history. Nine articles conducted internal validation, and three articles conducted both internal and external validation. Nine articles reported the area under the receiver operating characteristic curve, and only three articles reported the calibration of the model based on the Hosmer-Lemeshow test. PROBAST analysis showed that 10 articles were assessed as high risk bias, mainly stemming from statistical analysis. Conclusion Most of the MRSA infection risk prediction models in the current literature have good predictive efficacy for MRSA infection, but they all have higher overall risk of bias, and only a few models have undergone external validation. Researchers should follow PROBAST standards to construct and externally validate models in the future so as to develop models suitable for clinical practice.

Objective:To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies.Methods:This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M ( Q1, Q3). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results:The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk.Conclusions:iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.

The structure and size of the chloroplast genome of Castanopsis hystrix was determined by Illumina HiSeq 2500 sequencing platform to understand the difference between C. hystrix and the chloroplast genome of the same genus, and the evolutionary position of C. hystrix in the genus, so as to facilitate species identification, genetic diversity analysis and resource conservation of the genus. Bioinformatics analysis was used to perform sequence assembly, annotation and characteristic analysis. R, Python, MISA, CodonW and MEGA 6 bioinformatics software were used to analyze the genome structure and number, codon bias, sequence repeats, simple sequence repeat (SSR) loci and phylogeny. The genome size of C. hystrix chloroplast was 153 754 bp, showing tetrad structure. A total of 130 genes were identified, including 85 coding genes, 37 tRNA genes and 8 rRNA genes. According to codon bias analysis, the average number of effective codons was 55.5, indicating that the codons were highly random and low in bias. Forty-five repeats and 111 SSR loci were detected by SSR and long repeat fragment analysis. Compared with the related species, chloroplast genome sequences were highly conserved, especially the protein coding sequences. Phylogenetic analysis showed that C. hystrix is closely related to the Hainanese cone. In summary, we obtained the basic information and phylogenetic position of the chloroplast genome of red cone, which will provide a preliminary basis for species identification, genetic diversity of natural populations and functional genomics research of C. hystrix.
Phylogeny ; Genome, Chloroplast ; Codon/genetics* ; Genomics ; Chloroplasts/genetics*

Objective:To investigate the clinical features of adenoviral encephalitis (AE), and to provide reference for clinical diagnosis and treatment of adenoviral encephalitis.Methods:From January 2012 to December 2020, 1 185 cerebrospinal fluid (CSF) samples of hospitalized children with suspected central nervous system infection in the Second Affiliated Hospital of Shantou University Medical College were collected for the detection of 22 common respiratory pathogens and common pathogens for encephalitis by polymerase chain reaction. Records of patients with adenovirus positive in CSF were reviewed and relevant clinical manifestations, laboratory tests and imaging examination results were collected for analysis.Results:Among 1 185 CSF samples, 242 samples were positive for viral nucleic acid, with detection rate of 20.4%, including 1.9%(23/1 185) of adenovirus. As for 23 children diagnosed with AE, 18 were male, five were female, with the age of (44.8±35.9) months, ranging from two months and 19 days to 10 years. Of 23 children, 21(91.3%) presented with fever, followed by convulsions (16 cases, 69.6%), headache (four cases, 17.4%), vomiting (11 cases, 47.8%), consciousness change (11 cases, 47.8%) and emotion disturbance (three cases, 13.0%). Among 23 children, eight cases had white blood cell counts (WBC) of (6 to <10)×10 9/L, 10 cases had WBC of (10 to 20)×10 9/L and the white blood cell classification was mainly neutrophils (21 cases, 91.3%), and C reactive protein of 20 cases (87.0%) was in the normal range. Cerebrospinal fluid examination showed that WBC were less than 15×10 6/L in 20 cases (87.0%), and WBC ≥15×10 6/L in three cases, which were up to 500×10 6/L; the protein of 19 cases was in the normal range, the glucose of 15 cases was in the normal range, and the chloride of 19 cases was in the normal range. Among 16 cases with brain magnetic resonance imaging examination, eight cases did not show abnormality, six cases with local meningeal linear enhancement, one case with small intracranial malacia, and one case with extensive intracranial lesions. For 13 cases who received electroencephalogram (EEG) test, seven cases showed normal EEG or marginal state, four cases showed extensive medium and high amplitude slow wave, one case showed spike wave or spike slow wave and one case had both of the above two changes. Among 23 children, 22 cases recovered including one case had secondary epilepsy, and the remaining one case had severe brain dysfunction and was unable to suck when discharged, with an indwelling gastric tube and accompanied by secondary epilepsy. Conclusions:The clinical manifestations and auxiliary examinations of children with AE have no obvious specificity. Most children with AE have a good prognosis, but a small number of them may have serious sequelae.

To investigate the current status of the postpartum weight retention (PPWR) in Kaifu District of Changsha, and explore the influential factors with PPWR based on the generalized estimating equation model.
 Methods: A cluster sampling method was applied to select women who gave birth at the health service centers of 3 street communities in Kaifu District of Changsha during 2015. According to the inclusion and exclusion criteria, 783 cases were finally included in the study. Data on PPWR were collected prospectively by using the self-made questionnaire at 1, 3, 6 and 8 months after childbirth. Analysis were performed to investigate the associations between PPWR and its potential factors with generalized estimation equation model.
 Results: The mean PPWR of women was gradually decreased with the increase of postpartum time, and 34.6% of them have returned to the pre-pregnancy weight in the 8 months postpartum. Our findings revealed that gestation weight gain (GWG), pre-pregnancy body mass index, feeding patterns, and delivery mode were significantly associated with maternal PPWR (P<0.05). In contrast, maternal age, educational level, per capita income of family, parity and postpartum depression were not contributed to PPWR (P>0.05).
 Conclusion: GWG is one of the most important predictors for PPWR. The key to reducing PPWR is to control GWG systematically. Early targeted interventions and health education should be taken to prevent women from excessive PPWR at the first-year postpartum, in particular to the women who underwent cesarean deliveries and breastfed their infants. It is conducive to reduce the risks of overweight or obesity caused by PPWR.
Body Mass Index ; Female ; Gestational Weight Gain ; Humans ; Obesity ; Overweight ; Postpartum Period ; Pregnancy

Objective To investigate the expressions of tumor necrosis factor-alpha (TNF-α),tumor necrosis factor receptor (TNFR)1 and TNFR2 in different cervical lesions and their relationships with clinicopathological characteristics.Methods Forty-one cases of cervical squamous cell carcinoma (CSCC) patients (CSCC group) treated in 254th Hospital of People's Liberation Army from January 2015 to December 2017 wereselected as the subjects.Forty-nine cases of high grde squmous intrepithelial lesion (HSIL) (HSIL group) and fifty cases of uterine myoma (normal group) were selected as control groups.The expression of TNF-α in cervical tissues of different lesions was detected by immunohistochemistry.The expressions of TNF-α mRNA,TNFR1 mRNA and TNFR2 mRNA were detected by quantificational real-time polymerase chain reaction (qRT-PCR).The expression level of TNFR1 and TNFR2 proteins are measured by Western blotting.The relationships between the expression level of TNF-α mRNA,TNFR1 mRNA and the clinicopathological characteristics of patients were analyzed.Results The positive rates of TNF-α in the normal group,the HSIL group and the CSCC group were 8.0％ (4/50),59.2％ (29/49) and 73.2％ (30/41).The difference between three groups was statistically significant (x2 =44.786,P ＜ 0.001).The positive rates of the HSIL group and the CSCC group were significantly higher than that in the normal group,the difference was statistically significant (x2 =29.175,P ＜ 0.001;x2 =40.883,P ＜ 0.001),but there was no statistical difference in the positive rates of TNF-α in CSCC group and HSIL group (x2 =1.934,P =0.164).The results of qRT-PCR showed that the expressions of TNF-α mRNA in normal group,HSIL group and CSCC group were 1.32 ± 0.21,3.64 ± 0.41 and 7.51 ± 1.42.The difference of TNF-α mRNA expression among three groups was statistically significant (F =655.800,P ＜ 0.001).The expressions level of TNF-α mRNA in HSIL group and CSCC group were significantly higher than that in normal group (t =31.747,P ＜ 0.001;t =51.012,P ＜ 0.001),and the expression level of CSCC group was significantly higher than that in HSIL group (t =20.039,P ＜ 0.001).The expression levels of TNFR1 mRNA in the normal group,the HSIL group and the CSCC group were 0.42 ± 0.13,0.89 ±0.21 and 2.23 ± 0.46.The relative expression of TNFR1 mRNA between the three groups was statistically significant (F =465.900,P ＜ 0.001).The expression levels of TNFR1 mRNA in group HSIL and CSCC were significantly higher than that in normal group (t =13.357,P ＜ 0.001;t =26.587,P ＜ 0.001),and the expression level of CSCC group was significantly higher than that in HSIL group (t =18.407,P ＜ 0.001).The expression of TNFR2 mRNA in the normal group,the HSIL group and the CSCC group were 0.38 ± 0.14,0.41 ± 0.11 and 0.44 ± 0.12.There was no significant difference between three groups (F =2.633,P =0.075).Western blottting showed that the expression intensity of TNFR1 in the normal group,the HSIL group and the CSCC group were 0.84 ±0.18,1.95 ±0.21 and 3.38 ±0.73,the difference was statistically significant (F =398.000,P ＜ 0.001).The expression intensity of TNFR1 in group HSIL and CSCC were significantly higher than that in normal group (t =18.273,P ＜ 0.001;t =39.894,P ＜ 0.001),and the expression in CSCC group was also significantly higher than that in group HSIL (t =22.357,P ＜ 0.001).The expression intensity of TNRF2 in normal group,HSIL group and CSCC group were 0.98 ± 0.15,1.02 ± 0.17,1.07 ± 0.21,and the difference was not statistically significant (F =2.938,P =0.056).The results of protein detection were in accordance with the results of mRNA detection.The expression of TNF-α mRNA in the CSCC tissues was related to the size of the tumor (t =-8.868,P ＜ 0.001),the degree of differentiation (t =-5.644,P ＜ 0.001),the clinical stage (t =-19.329,P ＜ 0.001),the depth of infiltration (t =-11.170,P ＜0.001),and lymph node metastasis (t =-8.339,P ＜ 0.001).The expression of TNFR1 mRNA was closely related to the tumor size (t =-13.309,P ＜ 0.001),degree of differentiation (t =-13.449,P ＜ 0.001),clinical stage (t =-12.949,P ＜0.001),depth of infiltration (t =-18.124,P ＜0.001),and lymph node metastasis (t =-20.506,P ＜ 0.001).Conclusion In cervical cancer tissues,the expression intensity of TNF-α and TNFR1 increased abnormally,while TNFR2 did not change significantly.The expressions of TNF-α and TNFR1 are positively correlated with the malignancy of cervical cancer.They are potential signals of cervical cancer and are expected to become new therapeutic targets.However,the activation of TNFR2 to downstream signaling pathway is significantly weaker than that of TNFR1.

Objective:To determine influential factors for delayed breastfeeding initiation.Methods:Using questionnaires to collect the data of 950 pregnant women and infants' feeding practices in Changsha,Hunan,logistic regression and decision tree model were used to determine influential factors for delayed breastfeeding initiation.Results:Mothers with timely breastfeeding initiation were 594 (62.5％),and those with delayed breastfeeding initiation accounted for 356 (37.5％).Mothers with timely breastfeeding initiation were more likely to use exclusive breastfeeding than those with delayed breastfeeding initiation (P＜0.05).Four risk factors were found by logistic regression model and decision tree model,including cesarean delivery,using feeding-bottle before breastfeeding initiation,falling ill,and vomiting during pregnancy.Receiver operating characteristic curve showed no significant difference in the predictive effect of the 2 models (Z=0.142,P=0.889).Conclusion:Cesarean delivery,using feeding-bottle before initiation of breastfeeding,and poor physical condition during pregnancy exert negatively effects on breastfeeding initiation.Health workers should help mother to timely initiate breastfeeding and enhance their confidence in exclusive breastfeeding.

Objective To analyze the causes of unplanned tracheal extubation in mechanically ventilated patients in the pediatric intensive care unit using quality management practices and observe the changes of extubation rates before and after implementing these practices.Methods In the first place,we set up quality management group in June 2014.Second,the team formulated a risk factor checklist for unplanned tracheal extubation based on literature research, and analyzed the main causes requiring tracheal extubation. The last time,we developed some management measures for important reasons in 2014,and established and implemented a quality management strategy between 2015 and 2016.The incidence frequency of unplanned tracheal extubation,i. e. the number of extubation cases per 100 days with a tube in place(mechanical ventilation days),was used to evaluate the change of the extubation rates before and after implementing the new measures. The cases in 2014 were retrospectively analyzed,and cases from 2015 to 2016 were prospectively collected.The number of interval days for two continuity unplanned extubation was considered to be a means of quality control.Results Rick factors associated with unplanned extubation in the pediatric intensive care unit before implementing quality management were a delay of the replacing adhesive bandage, lack of sedation assessment,which were related to frequent physician replacement and insufficient training and supervision.In consideration of the identified risk factors,a standard operating procedure was formulated to prevent unplanned extubation,including standard operating procedure of tracheal catheter fixation and the sedation assessment. There were 484 mechanical ventilation in 2014,and the incidence of unplanned extubation was 0.8%,and the median number of days of separation was 8.0(4,20) d.Between 2015 and 2016,there were 1 379 mechanical ventilations,and the incidence of unplanned extubation was 0.2%,and the median number of days of separation was 34.0(19,61) d.The incidence of unplanned extubation in 2015 to 2016 was lower than that in 2014(χ2=5.936,P=0.018).Ramsay scoring usage increased from 28.6% in 2014 to 57.1% between 2015 and 2016,while Ramsay scored 3-4 points from 2015 to 2016 was higher than 2014(P< 0.05).Conclusion Establishing the quality management group according to the requirements of each hospital and implementing quality management strategies can reduce the incidence of unplanned extubation,thereby improving the quality of care in pediatric intensive care unit.

Objective: To investigate the association between hepatic controlled attenuation parameter (CAP) and metabolic syndrome (MetS) and the correlation of CAP and its changes with the incidence of MetS. Methods: A total of 2461 subjects who underwent physical examination from July 2013 to September 2015 were enrolled. Spearman correlation analysis was used to investigate the correlation of CAP with the number of MetS components and each MetS component, and the chi-square test was used to investigate the prevalence rates of MetS and each component under different CAP levels. Logistic regression analysis was used to analyze the odds ratio (95% confidence interval (CI)) of MetS under different CAP levels. A total of 230 subjects without baseline MetS were selected; in a prospective cohort study, these subjects were divided into groups according to the baseline CAP, change in CAP, and percent change in CAP, and the chi-square test was performed to compare the incidence of MetS. The Cox regression analysis was used to analyze the values of baseline CAP, change in CAP, and percent change in CAP in predicting MetS. Results: CAP was positively correlated with the number of MetS components (r = 0.309, P < 0.01) and significantly correlated with all components. There were significant differences in the prevalence rates of MetS and its components under different CAP levels (< 238 dB/m, 238-258 dB/m, 259-291 dB/m, and ≥292 dB/m) (P < 0.05). After the adjustment for sex and age, with < 238 dB/m as a reference, the odds ratios (95% CI) of MetS in patients with CAP levels of 238-258 dB/m, 259-291 dB/m, and ≥292 dB/m were 1.784 (1.369-2.325), 2.936 (2.292-3.760), and 4.363 (3.435-5.543), respectively (all P < 0.05). Follow-up data showed that 28 patients (12.2%) developed MetS. After the adjustment for related factors, the hazard ratios (95% CI) of MetS in patients with baseline CAP > 238 dB/m, change in CAP > 30 dB/m, and percent change in CAP > 25.0% were 3.337 (1.163-9.569), 7.732 (2.453-24.366), and 11.656 (3.329-40.813), respectively (all P < 0.05). Conclusion CAP is closely associated with MetS and its components. CAP and its change can be used to predict the risk of MetS.